Clamour grows for heroin on the NHS

By Terrapinzflyer · Sep 14, 2009 · ·
  1. Terrapinzflyer
    Clamour grows for heroin on the NHS
    Experts call for national network of 'shooting galleries' after hailing successful trials

    A group of government-appointed drug experts will call for a nationwide network of "shooting galleries" to provide injectable heroin for hardened drug addicts across the country.

    A pioneering trial programme prescribing heroin to long-term addicts has shown "major benefits" in cutting crime and reducing street sales of drugs. Results of the programme are to be presented at a conference in London tomorrow. An expert group set up by the National Treatment Agency for Substance Misuse to assess the programme has concluded that the approach should be adopted nationwide.

    The prescription of heroin to hardened addicts is one of the most controversial in medicine. Giving addicts drugs such as heroin on a maintenance basis, rather than weaning them off them, turns existing policy on its head and presents a challenge to ministers.

    Critics say giving addicts the drugs they were previously scoring on the street is not "treatment", and the cost at £15,000 a year per head cannot be justified when NHS patients are being denied the latest cancer drugs. But addiction experts say this is about "harm reduction", not cure.

    Long-term heroin users are among the hardest addicts to treat and impose huge costs on the medical and penal systems. Ten per cent of drug addicts commit three-quarters of all acquisitive crime in the UK, official figures show. The existing government drugs strategy includes a commitment to roll out the clinics, subject to the findings of the trial programme.

    The trial started three years ago and yielded benefits within months. Early results showed crimes committed by the addicts dropped from about 40 to six a month, after six months of treatment. A third of the addicts stopped using street heroin and the number of occasions when the rest "scored" dropped from every day to four to five times a month.

    The programme was modelled on one in Switzerland where introduction of injecting-clinics "medicalised" heroin use, removing its glamour and transforming it from an act of rebellion to an illness requiring treatment. Last year, Swiss voters backed the scheme in a referendum, proving it could be a vote-winner. Similar clinics have also been established in France, Germany and Canada.

    The first British injecting clinic, run by the Maudsley Hospital, opened on a south London high street in 2005. Heroin addicts who had failed on all other treatments and served repeated prison sentences for shoplifting and other crimes attended twice a day and received a dose of diamorphine (pharmaceutical grade heroin) which they injected themselves, under supervision.

    Two further clinics were opened, in Darlington in 2006 and in Brighton in 2007. For the trial, 150 addicts received drugs at the clinics, one third of them heroin. Their experience was compared with two other groups who received either oral or injectable methadone under the same conditions.

    The strict rules allow no "take-away" from the clinics, to avoid the users selling their drugs on the streets. All injections are witnessed at the clinic. The approach introduces routine and drudgery by forcing the users to attend for their twice-daily fix.

    There are an estimated 280,000 drug users in the UK, most taking heroin and crack cocaine, and about 2,500 deaths a year. The scheme, targeted at the 3,000 to 6,000 long-term, hardcore addicts, operates seven days a week, 365 days a year.

    Professor John Strang, head of the National Addiction Centre at the Maudsley, who led the study, said the findings had sent a ripple of excitement through the addiction treatment community, which is unused to seeing progress with hardcore heroin addicts. He would not comment yesterday on the panel's recommendations, but before, speaking about the early successes of the trials he said: "This is genuinely exciting news. These are people with a juggernaut-sized heroin problem and I didn't know whether we could turn it around. We have succeeded in people who looked as if their problem was unturnable, and we have done it in six months.

    "It is 'intensive care' for drug addicts, more expensive than standard treatment but a third of the cost of sending them to prison at £44,000 a year. And they become re-addicted on release. We are dealing with a profound drug hunger and trying to medicalise it to break the link with street heroin use and crime."

    War on drugs: The liberal experiments


    Doctors have been allowed to prescribe heroin since the 1920s but very few do so. Most prefer to prescribe methadone, a heroin substitute, which is taken orally once a day. Its effects are longer-lasting but duller. Many addicts continue to buy heroin. There are currently three "shooting galleries" operating across the country which may now be extended.


    Throughout the mid-1990s the Swiss were at the forefront of trialling prescription heroin schemes and the country has seen a major reduction in crime and better rehabilitation success rates. For years the main "shooting gallery" was in Zurich but last year Swiss voters approved a nationwide rollout of prescription heroin in a referendum.


    Portugal has the most liberal drugs policy in Europe. In 2001, it took the radical step of abolishing criminal penalties for drugs. Anyone caught with drugs was referred through the civil, rather than criminal, courts and either fined or put into treatment. Critics predicted that narcotics use would spiral out of control but addiction rates fell.

    Related Articles
    Leading article: An injection of common sense
    Drugs analysis: 'We need to get people away from dealers'

    By Jeremy Laurance, Health Editor
    Monday, 14 September 2009

    Share This Article


  1. Terrapinzflyer
    Heroin 'shooting galleries' should be introduced
    The Government should introduce "shooting galleries" where drug addicts can safely inject themselves with heroin nationwide, a panel of experts will argue.

    They will say that the galleries, which will administer the drug to addicts, rather than weaning them off it, will cut crime and reduce street dealing.
    A pioneering trial programme prescribing heroin to long-term addicts showed "major benefits". Results of the programme are to be presented at a conference in London tomorrow.

    An expert group set up by the National Treatment Agency for Substance Misuse to assess the programme has concluded that the approach, which costs around £15,000 per head, should be adopted nationwide.
    The trial, which started three years ago, resulted in crimes committed by addicts dropping from about 40 to six a month, after six months of treatment.
    A third of the addicts stopped using street heroin and the number of occasions when the rest "scored" dropped from every day to four to five times a month.
    The first British injecting clinic, run by the Maudsley Hospital, opened on a south London high street in 2005.
    Two further clinics were opened, in Darlington in 2006 and in Brighton in 2007. For the trial, 150 addicts received drugs at the clinics, one third of them heroin.
    There are an estimated 280,000 drug users in the UK, most taking heroin and crack cocaine, and about 2,500 deaths a year.
    The scheme, targeted at the 3,000 to 6,000 long-term, hard-core addicts, operates seven days a week, 365 days a year.
    Professor John Strang, head of the National Addiction Centre at the Maudsley, who led the study, would not comment on the panel's recommendations.
    But he has said before that the results of the trial have been "genuinely exciting"
    "These are people with a juggernaut-sized heroin problem and I didn't know whether we could turn it around. We have succeeded in people who looked as if their problem was unturnable, and we have done it in six months.
    "It is 'intensive care' for drug addicts, more expensive than standard treatment but a third of the cost of sending them to prison at £44,000 a year", he said.
    "And they become re-addicted on release. We are dealing with a profound drug hunger and trying to medicalise it to break the link with street heroin use and crime."

    By Ben Leach
    Published: 7:00AM BST 14 Sep 2009
  2. Terrapinzflyer
    Heroin on the NHS will not help the biggest victims - the addicts' families

    While the Government threatens to cut child benefit for the middle class in order to reduce the country’s banana republic-level of national debt, the Independent is calling for heroin to be made available on the NHS, along with boob jobs, Viagra, non-medical abortions and all the other things William Beveridge had exactly in mind when he set it up.
    This “clamour” for free heroin, at the cost of £15,000-per-(smack)-head, came about after a group led by the National Treatment Agency for Substance Misuse successfully reduced the amount that addicts stole over a certain period.
    The trial started three years ago and yielded benefits within months. Early results showed crimes committed by the addicts dropped from about 40 to six a month, after six months of treatment. A third of the addicts stopped using street heroin and the number of occasions when the rest “scored” dropped from every day to four to five times a month.
    Anyone can see that if it stops people stealing, dealing, overdosing or contracting HIV, it’s worth a try, and it’s certainly a bonus that the Government will try to put drug dealers out of business using the same method employed against commercial broadcasters – setting up a gigantic, tax-payer funded monopoly.
    But for whose benefit is this? The debate about drugs policy has traditionally been discussed in terms of the harm to the addict vs the harm to society. Drug addiction physically damages the users in a number of ways, but that harm is certainly increased by prohibition, which forces the addict to buy unregulated street heroin; drug addiction also harms society because addicts are responsible for the overwhelming majority of theft in this country. This scheme seems to solve both problems.
    Except the one group never consulted or considered: the family and friends of the addict, who are the biggest victims of this non-victimless crime. While no doubt they do not want their loved ones exposed to the dangers of scoring and all that entails, neither would they want the Government to act as enabler, and this programme seems to make no attempt to get addicts off drugs, which at least prison aspires to (in theory), but only to minimise the irritation it causes to those not directly connected to the addict. That seems like not only a short-term policy akin to Danegeld for junkies, but also a selfish one.
    Still, at least Independent readers won’t have to walk past drug addicts on their way back from the theatre.

    Ed West
    Ed West is a journalist and social commentator who specialises in politics, religion and low culture. Embarrassingly, he once wrote a book entitled How To Pull Women.

  3. Terrapinzflyer
    Heroin supply clinic 'cuts crime

    A scheme in which heroin is given to addicts in supervised clinics has led to big reductions in the use of street drugs and crime, the BBC has learned.
    More than 100 users took part in the pilot - part funded by the government - in London, Brighton and Darlington.
    They either injected heroin or received the drug's substitute methadone.
    Those given heroin responded best and an independent panel which monitored the scheme over six months are advising ministers to set up further trials.
    About three-quarters of those given heroin were said to have "substantially" reduced their use of street drugs.
    Research suggests that between half and two-thirds of all crime in the UK is drug-related.
    The Home Office says on its website that about three-quarters of crack and heroin users claim they commit crime to feed their habits.

    Three-quarters reduced use of street heroin
    Offences down from 1,731 in 30 days to 547 in six months
    Spending on drugs down from £300 to £50 a week
    Figures for group given heroin
    Professor John Strang, who led the project, said the results were "very positive" because the scheme had helped cut crime and avoid "expensive" prison sentences.
    Professor Strang, who is based at the National Addiction Centre, part of King's Health Partners, said the individuals on the programme were among those who had been the hardest to treat.
    "It's as if each of them is an oil tanker heading for disaster and so the purpose of this trial is to see: 'Can you turn them around? Is it possible to avert disaster?'
    "And the surprising finding - which is good for the individuals and good for society as well - is that you can," he said.
    The Randomised Injecting Opioid Treatment Trial (RIOTT) programme - which is funded by a number of agencies, including the Department of Health - began in 2005.
    It involved 127 chronic heroin addicts for whom conventional types of treatment had failed.
    Many of the addicts were also using other substances, including crack cocaine.
    During the trials, a third of addicts were given the heroin substitute methadone orally and another third injected methadone under supervision.
    The remainder, observed by nurses, injected themselves with diamorphine - unadulterated heroin - imported from Switzerland.
    National roll-out?
    Those on the programme were also given psychological support and help with their housing and social needs.
    The results showed that addicts in all three groups cut the amount of heroin they obtained illicitly from street dealers.
    According to researchers, more than half of the heroin injecting group were said to be "largely abstinent" and one-in-five did not use street heroin at all.
    Before they began the programme, the addicts in the heroin injecting group were spending more than £300 a week on street drugs. After six months, this had reduced to an average of £50 a week.

    It used to be about chasing the buzz, but when you go on the programme you just want to feel comfortable
    John, RIOTT participant
    There was also a big drop in the number of offences addicts admitted committing to obtain money to feed their habit.
    In the previous month before the scheme started, addicts in the heroin injecting group reported carrying out 1,731 crimes.
    After six months, this had fallen to 547 offences - a reduction of more than two-thirds.
    One of the heroin addicts on the programme, a 34-year-old man called John, had been addicted for eight years when the trials began. He fed his habit by dealing.
    "My life was just a shambles... waking up, chasing money, chasing drugs," he said.
    But John said the scheme had transformed his life "100 per cent" and he now had a part-time job.
    "It used to be about chasing the buzz, but when you go on the programme you just want to feel comfortable," he said.

    Many participants "substantially" reduced their use of street drugs
    "I've started reducing my dose gradually, so that maybe in a few months time I'll be able to come off it altogether, drug free totally."
    In its drug strategy, published last year, the government said it would "roll out" the prescription of injectible heroin, subject to the findings of the pilot scheme.
    The National Treatment Agency for Substance Misuse (NTA), which administers drug treatment in England, said the results were "encouraging".
    The NTA said an independent expert group, set up to advise the government, had concluded that there was enough "positive evidence of the benefits" of the programme to merit further pilots.
    The NTA is understood to be keen to evaluate the financial implications of the scheme. At £15,000 per user per year, supervised heroin injecting is three times more expensive than other treatments.

    By Danny Shaw
    BBC home affairs correspondent
    there is video footage on the bbc story as well
  4. Motorhead
    Results of the Randomised Injectable Opioid Treatment Trial (RIOTT)

    The most chronic heroin addicts in the UK can be treated successfully using a radical new treatment model, researchers at King’s Health Partners Academic Health Sciences Centre (AHSC) have found.

    Participants in the trial - the first of its kind in the UK - were among the 5% of heroin users for whom treatment, rehabilitation and even prison have had little effect, often over many years of addiction. For these people, daily use of ’street heroin’ has been the norm, even while in conventional treatment.

    The headline results from RIOTT are made public today (15 September 2009) at a conference at the Royal College of Physicians organised by the charity Action on Addiction.

    RIOTT is the first randomised controlled trial in the UK to compare injectable opiate treatment (injectable methadone and injectable heroin) delivered in new medically supervised injecting clinics to optimised (high quality) oral methadone for severely entrenched and ‘hard to treat’ heroin addicts.

    The RIOTT trial has been coordinated by the National Addiction Centre which was developed by the Institute of Psychiatry, Kings College London, and South London and Maudsley NHS Foundation Trust (SLaM). The research was funded by the Big Lottery through the charity Action on Addiction in partnership with the National Treatment Agency who have funded the supervised injecting clinics on behalf of the Government.

    The RIOTT trial took chronic heroin addicts who, despite active treatment, were still continuing to inject heroin most virtually daily. These entrenched heroin addicts were then randomised to treatment with either supervised injectable heroin, supervised injectable methadone or optimised oral methadone.

    Three supervised injecting clinics have been established in England in recent years and these are the sites for the trial , - in London (SLaM - established October 2005), Darlington (began September 2006) and Brighton (began September 07).

    About the trial

    This treatment was for a select group of heroin addicts

    • entrenched heroin addicts who have repeatedly been found to fail to benefit from existing treatments
    • existing clients who despite receiving oral methadone maintenance treatment were continuing to inject street heroin almost every day.
    These supervised injecting clinics provide intensive treatment

    • providing a prescription of injectable heroin and injectable methadone injected under strict medical supervision
    • with a high level of psychological and social support to address health and life issues
    • the trial compares injectable heroin and injectable methadone delivered in supervised injecting clinics with high quality conventional treatment (oral methadone)
    Key findings
    This trial shows that it is possible to engage and retain in treatment some of the most entrenched hard-to-treat heroin addicts for whom previous treatment, rehabilitation and prison appear to have had little beneficial impact. These are existing clients who despite receiving oral methadone maintenance treatment were continuing to inject street heroin almost every day:

    • All groups achieved good retention
    • Better retention in the injectable heroin group (88%) compared to 81% in the injectable methadone group and 69% in the oral methadone group
    The trial has achieved very positive results in terms of the primary outcome measure - reduced use or abstinence from ’street’ heroin. There was a reduction in street heroin use amongst all 3 treatment groups at six months. The most pronounced reduction was seen in the injectable heroin group:

    • Three quarters responded well by substantial reduction in the use of ’street’ heroin.
    • Of these, three quarters (or around 60% of the total group) remained largely abstinent allowing for no more than two lapses in drug testing during a three month period.
    • A quarter of those who reduced (almost 20% of the total group) were totally abstinent from street heroin. This is remarkable in a group for whom daily illicit use while in treatment was the norm.
    For the injectable methadone and oral methadone groups, the achievements were much more modest. About a third were no longer using street heroin regularly, although very few of these were totally abstinent from street heroin.

    There was an almost immediate benefit just 6 weeks into treatment and this benefit was maintained throughout the six-month period of study for each patient

    The degree of effect of the treatment was greatest in the injectable heroin group, followed by injectable methadone and optimised oral methadone.

    Optimised oral methadone showed greater success than predicted, perhaps due to the high intensity of engagement provided by regular attendance and psychosocial support. At the same time the injectable methadone group performed less well than predicted, though still with a positive effect.

    The amount of money spent on street drugs reduced in all treatment groups.

    The biggest reduction was seen in the heroin group.

    • Clients were spending an average of just over £300 a week on drugs before entering RIOTT treatment (despite already being in active treatment) and this reduced to an average of just under £50 a week at 6 months.:
    • This was as a result of (a) substantial numbers who became ‘crime-abstinent’, and also (b) substantial reduction in the extent of criminal activity of those who were still criminally involved.
    • The total spending for the whole heroin group (approximately 40 people) translates as reducing from nearly £14,000 spent a week prior to entering RIOTT which then reduced to under £2,000 at 6 months.
    Across the board there was a dramatic reduction in self-reported crime:

    • Prior to entering RIOTT treatment over half of the clients in each treatment group were committing crime and were commiting a mean number of between 20-40 crimes in the past 30 days.
    • At six months, the proportion committing crimes in each group more than halved and the mean number of crimes committed in the past 30 days reduced to between 4 -13 - less than a third of previous levels.
    • The actual number of crimes committed drastically reduced by two thirds in each group. For example, those in the heroin group were committing a total of 1731 crimes in the 30 days prior to entering RIOTT treatment and after 6 months, this fell to 547 crimes (a reduction of 1,184 crimes per month).
    Prior to entering RIOTT treatment, around three quarters of each group were using crack. It has been thought that crack use might increase amongst clients receiving injectable opiate treatment. wever, this was not the case and at 6 months the proportion using crack had reduced across all treatment groups as had the amount used.

    These clients were existing service users and already receiving oral methadone treatment prior to entering RIOTT. Their levels of street heroin and crack use, money spent on drugs and criminal activity were occurring whilst receiving conventional treatment. It is all the more remarkable that such benefits have been made with the RIOTT treatment but in particular with injectable heroin.

    There were improvement in physical, mental health and social functioning across all treatment groups over the 6 month period.

    The cost of producing positive results in this ‘difficult to treat’ group is around £15k per patient per year. These are the most severe 5% of the heroin using population, many of whom are typically committing a high level of crime to fund their addiction. By comparison the typical cost of prison is £44k a year per person, not to mention many other costs to society.

    Sept 15, 2009
  5. Terrapinzflyer
    Spectacular results or spectacular spin behind Jack Straw’s call for heroin prescribing?
    “I ask myself this question: if there had been legal shooting galleries with free heroin in the UK years ago would I have ever got clean and sober. The answer to that is a categorical no.” Steve Spiegel, CEO, The Providence Project, 16th September 09

    ‘Clamour grows for heroin on the NHS’ shouted the Independent last week. This was news to me, as I imagine it was to the rest of that morning’s readers. A group of nameless government appointed drug experts were, I read, calling for a nationwide network of prescribing centres. A pioneering heroin prescribing programme trial had shown “major benefits in cutting crime and reducing street sales of drugs” it was claimed.[1] The article, an exclusive from health editor, Jeremy Lawrence, quoted the trial’s ’study leader’ Professor Strang, as saying: ‘the findings have sent a ripple of excitement through the addiction treatment community, which is unused to seeing progress with hard core addicts.’ By Sunday the ripple had reached Jack Straw, reported in the Sunday Times as calling for heroin prescribing on the NHS

    The ripple that reached me however was of disbelief and frustration. Steve Spiegel, a former ‘hard core’ addict now long term director of the Providence Project - the hugely successful abstinence based, low cost rehabilitation centre for those the system has failed, emailed me: “Next they’ll be prescribing alcohol to alcoholics and crack to crack addicts! Who are these so-called experts? I’m not sure where they get their facts from regarding heroin users being the hardest to treat. This is certainly not our experience.” For Theodore Dalrymple this was “the latest expensive scheme to avoid admission of the obvious, that we have been barking up the wrong tree for years.”

    Sadly the main body of the media had not shared his scepticism. On Tuesday morning, embargo raised, this ’success’ story led the news. On BBC Online, Home Affairs Correspondent Danny Shaw wrote ingenuously, ‘Heroin Supply Clinic Cuts Crime’. Radio 4’s Today programme ran his sympathetic news features through the morning and gave a platform to Professor Strang to assert: “The reductions in heroin use were spectacular, and those are validated”. Would people get this detail later in the day, he was asked. “Yes” came the reply, “later in the day and later, in proper scientific publications.”

    Hmm. My suspicion that this was a case of the media cart before the academic horse was confirmed: “The next stage is for us to make our results publicly available and it’s a great privilege to be doing it on the programme today,” the Prof added.

    More a case of spin and announce than of publish and be damned and never mind the principle of independent peer group review and only then to be followed by publication. And so it proved.

    Kings College Institute of Psychiatry, the umbrella institution for the trials, had also lost its academic inhibitions - its website displayed the banner: ‘RIOTT a success for chronic heroin addicts’ but gave no link to a publication or a report, only to details of the aim and method of the project. ‘Headline results’ it said, had been presented that day to a conference organised by the charity, Action on Addiction. To their website I duly proceeded, to find ….. no report, not even any headline results.

    Yet Kings College does not have to be told that it is a long established tradition in scientific research to release research findings to the media only after the process of anonymous and independent peer review. A principle of fundamental importance, not least because hot house reporting of dramatic research findings in the media is not the forum to objectively consider the accuracy of the results or indeed the robustness of the methodology. In fact it is a principle that provides just the corrective for any temptation researchers have to use the media to influence professional and political opinion, confident that they are right but unwilling to subject their research to independent assessment. Professor Strang knows this as does any researcher worth their salt.

    Yet in this instance he has clearly chosen to sacrifice it in favour of securing widespread media coverage. He has indicated that he will seek independent peer review and publication of the results of the heroin prescribing trial later. But he can save himself the postage of sending his research papers to the British Medical Journal or the Lancet - both of these internationally recognized medical journals exhort researchers not to release findings for public discussion before they have been assessed independently and published within the journals concerned. As a member of the editorial staff of another academic journal, Addiction, Professor Strang has shown a remarkable disregard for this principle of due process. Judging by the media response to whatever ‘results’ press release or briefings he selectively gave, he has indeed achieved the aim he may have set himself - of influencing public, professional, and political opinion in the direction of supporting heroin prescribing.

    For this reason alone his research findings should be regarded not with uncritical enthusiasm but with considerable caution. It is notable too that the last substantive Cochrane Review of four such randomised trials to test the efficacy of heroin maintenance versus methadone or other substitution treatments published in 2005 for patient treatment retention, reducing illicit use and for improved health and social functioning concluded: ‘No definitive conclusions about the overall effectiveness of heroin is possible’.

    Until that due process is completed we have to accept as an act of faith that Professor Strang’s small sample will tell us something quite different. We may have to wait. In response to my request for a publication, report or research evidence to the Institute of Psychiatry I received this from Nicola Metrebian, PhD, a Senior Research Fellow, RIOTT trial coordinator at the National Addiction Centre, Institute of Psychiatry, Kings College London: “Thank you for your interest in RIOTT. The findings have not been published and are not yet in the public domain”.

    Her reply begs the question of when is research in the public domain. Not evidently for the Institute of Psychiatry when it appears on their website, as front page newspaper headlines and is flagged up on the BBC with the full cooperation and appearance of the research ’study leader’.

    Jack Straw should be aware of this and of the as yet very flimsy basis of his dramatic and potentially dangerous policy development. The facts gleaned from ‘the public domain’ are overwhelmed by those that remain unknown:-

    * 127 subjects across 3 sites were randomly assigned to oral methadone, to injected methadone and to injected heroin - subjects described as ‘having failed’ all other treatments. (Unknowns: Assessment according to the internationally accepted ’severity of dependence’ criteria; Prior treatment experience or psycho social or follow up support. Data on age, life histories, co-morbidity. Data about programme retention and drop out, etc).

    * The ‘heroin group’ subjects with up to three diamorphine injections a day were still in the main street heroin dependent, 75% had reduced their use of street heroin as a result, but only 20 % per cent of these now ‘abstinent’ from illicit street heroin (Strang on Today). ‘The rest’ still ’scoring’ 4 to 5 times a month (The Independent) despite the high levels of heroin provided. (Unknowns: Continuing dependence on other substances including alcohol; prescribing patterns, continuing street dependence patterns for the two other groups etc.)

    * Subjects self report drops in their criminal offences from 40 to 6 per month. (Unknowns: Which? Variation across the three groups? Reliability? One magistrate commented, in the absence of objective evidence this would be thrown out of court.)

    The crime reductions and the speculated cost savings led the headlines. Journalists betrayed a disturbing credulity. None asked about the ‘Hawthorne effect’. Yet had any asked to visit the trials, as I did at the start of the project or how much it was costing (I was told some £500,000 to set up and administer the Darlington site for their thirty subjects alone) they might have noted the stark contrast between this gleaming new clinical setting, the attractive and sympathetic fully trained nurses devoted exclusively to them, with the dilapidated drug services centre on offer to every other addict down the road.

    With short policy memories too none remembered that similar self report claims for crime costs savings - estimates that have continued to be effectively spun - for methadone prescribing were made ten years ago, by some of the people involved in this latest project ….

    If Jack Straw thinks this amounts to sufficient evidence for heroin prescribing - the inevitable abuse of which was the start of the country’s drug problem in the 1960s - then we have to assume that whatever powers of analysis and critical thought he ever had, have now totally deserted him.

    Source: by Kathy Gyngell, Centre for Policy Studies Posted on: 27th September 2009’s-call-for-heroin-prescribing-6850.html
  6. Cooki
    Should heroin be available on the NHS?

    Should heroin be available on the NHS?

    Jack Straw, the Justice Secretary, believes that prescribing the drug to addicts would help to cut crime

    Martin Barnes, Chief executive, Drugscope

    Under the name diamorphine, heroin is used routinely in the NHS to relieve severe pain caused by accident, injury or illness. The prospect of heroin having an additional role in healthcare moved a step closer this month*. The results of a four-year trial confirm that the provision of legally prescribed heroin can be effective in helping addicts who have failed to gain from other treatment interventions. While the trial results generated some misleading headlines, there was not the anticipated storm of protest. In fact, the trials even generated political support.

    Those headlines describing “shooting galleries” and predicting a heroin free-for-all on the NHS are wide of the mark. The trial results took so long to be announced because the eligibility criteria and the stringent demands made on those taking part meant it was difficult to recruit volunteers.

    Patients whose persistently chaotic lifestyles made them pretty impervious to treatment were expected to turn up twice a day for injections that had to be taken on the premises and co-operate with all the other procedures in place for a proper trial. Should heroin prescribing be extended, the rules of engagement for addicts will be stringent and only a minority of heroin users would be involved.

    There is no silver bullet for effective drug treatment but the trial results suggest heroin prescribing can play a role in our drug treatment system alongside other measures. The results of the trials are in line with similar initiatives in, for example, Switzerland, Canada and Germany: sustained engagement with treatment, a significant reduction in offending and acquisitive crime and a path out of addiction which may previously have seemed impossible.

    The evidence in favour of heroin prescribing is strong and compelling, but plans to extend the pilots will undoubtedly prove controversial. Drug users and particularly drug addicts are a deeply unpopular, feared and despised group. The fact that they are somebody’s son, daughter, brother, sister or parent and that many will have experienced abuse, trauma or have mental health problems, is overlooked — instead, they are too often condemned as “undeserving”. Because many commit crime to pay for their drugs, negative responses are reinforced and, perversely, there is no guarantee that measures intended to address a root cause of the offending, such as heroin prescribing, will be supported.

    A DrugScope/ICM poll showed that one in five adults has direct or indirect experience of someone with an addiction and the findings suggest that the public’s views about drug use and addiction are more sympathetic than may sometimes be assumed by policymakers and commentators. The sky has not fallen in on those politicians, such as Jack Straw and Chris Huhne, who recently went on record as supporting heroin prescribing. Indeed one politician who supported the measure in 2002 has since gone on to lead the Conservative Party.


    Neil McKeganey,Director of the Centre for Drug Misuse Research, University of Glasgow

    There are a whole host of problems associated with prescribing heroin. First, I think it stretches our understanding of what treatment is when we find ourselves providing the addict with the drug to which they are addicted and have sought help from health services in overcoming.
    When drug abuse treatment services take on responsibility for providing addicts with the drug they are dependent on, it can fundamentally compromise the therapeutic relationship they should have with addicts. The focus for services should be about getting addicts off drugs, not facilitating their continuing dependence.
    I feel uncomfortable when police officers and justice secretaries enthusiastically advocate heroin prescribing. They see it as a way of reducing crime. It is quite wrong that medical treatment should be recommended on the back of its crime-reducing capacities. We are in danger of developing “social problem prescribing”.

    Although one can devise a pilot programme through which heroin is provided to a tiny number of addicts, once that kind of commitment is entered into more widely the worry is that services will provide heroin to addicts in a much less intensive way. Prescribing heroin is extraordinarily expensive and there is a real worry that services start to scale back the level of support that would need to accompany heroin prescribing.

    Because a treatment hasn’t worked I don’t feel that we should then start prescribing the drugs that are at the root of the addiction. Addicts are getting the drug they need without committing the crimes to get it. That is not what drug treatment services should be about — it should be about enabling individuals to become drug free, not compromising the work of addiction staff by providing the addict with the drug they are dependent on.

    Treatments for heroin addiction fail for a variety of reasons. The main one is that the addicts are not fully committed to coming off drugs.
    When the individual is committed, although it is incredibly difficult, they can succeed. In these cases the negative experiences of heroin addiction have led the individual to say: “I’ve had enough of addiction” — and that is a motivation to change. If you are complicit in providing them, where would they then go? The doctor is then effectively their drug dealer.

    We know that the addict’s journey to recovery is shaped by the sheer unpleasant inconvenience of maintaining their habit day after day. If the NHS has rubbed the hard edges off the habit — effectively saying: “You don’t need to be a criminal. We will provide you with the drug, clean needles in a clinic with nurses present” — one of the important drivers of recovery is being diluted.
    The addict may never reach a point where they say: “This lifestyle can’t go on like this.” The negative experiences involved in feeding the habit are part of what it is to be addicted and, crucially, part of the process of recovery.

    Article from:
    Date: archive: 25 September* 2009, The Times
    Picture taken from:

    Note: I hope it's ok to add an article almost a month old, but I thought it was a well-structed debate, and added to arguments/news reports that focussed on this current, controversial news topic.
  7. chillinwill
    Re: Should heroin be available on the NHS?

    Please note that the way we post news has changed, because of our main news page. You can find the full instructions here.

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  8. ramjet
    Re: Should heroin be available on the NHS?

    An interesting related article from a few years back:

    (not sure how to post pictures, sorry :()


    Get caught with heroin and you face seven years in prison. But not Erin O'Mara, one of 440 addicts in the UK to get a regular fix from an NHS prescription - an arrangement she says has turned her life around.

    Erin O'Mara is a bright, bubbly magazine editor - hardly the stereotype of someone who injects heroin four times a day.

    But her habit, now in its 20th year, does not line the pockets of a drug dealer. The 34-year-old gets her fix from her local chemist in west London. This "perfect prescription", as she calls it, began two years ago and rescued her from a life of prostitution, drug dealing and serious illness.

    The downward spiral began with Erin's first taste of heroin aged 15 while in her native Australia, and has included 10 unsuccessful methadone programmes along the way.

    To finance her habit, she began working as a masseuse, which led to escort work and then street prostitution. That stopped when she discovered she was HIV positive.

    But the prescription has transformed her life. As founder of Black Poppy, a magazine by and for drug users, she addresses drug conferences and is being consulted about pilot projects.

    Sitting in her office, she says: "My prescription has meant I have money now, and choices I can make in my life - simple things like what I want for dinner. I can do things I haven't done for years and can think five years ahead. Before I was just thinking about my next 'hit'."

    - 4 x 100mg diamorphine (solid)
    - 4 x sterilised water
    - 4 x sterilised needles
    - 4 x swabs
    - pharmaceutically prepared
    - advice leaflet enclosed

    Each shot supplied by her chemist is just enough to enable Erin to function properly and prevent the onset of withdrawal. She only feels the buzz if she relaxes.

    The NHS allows only licensed doctors to prescribe diamorphine, the medical name for heroin, to addicts if they have failed to respond to methadone treatment. At present just 0.5% of those in treatment are prescribed heroin, but new pilot projects are expected to increase that number.

    Supporters of this policy, such as the independent research group DrugScope, say controlled distribution by the state can drastically reduce crime.

    They also argue that clean heroin like diamorphine is not in itself dangerous, just incredibly addictive. And a pharmaceutical prescription excludes all the risks associated with unsafe injecting and enables the user to gradually be weaned off the drug.

    Topped up doses

    Erin believes this approach can save lives. But prescribing heroin is not always the answer, as she herself knows from the first programme she took part in in 1998.

    - Prescriptions peaked in 1960s
    - The UK is one of the few countries to allow it
    - Any doctor can prescribe it for medical conditions, but need Home Office licence to treat addiction
    - Home Office says every £1 spent on drug treatment saves £3 in less crime
    (Source: Drugscope)

    Prescribed heroin 'safe'

    "The whole set-up was really oppressive and heavy-handed, but the doses were too low so people were using other drugs and too scared to admit it. No-one was happy and no-one was doing well on it. The carrot and stick approach doesn't work because you can't punish users enough to make them stop".

    One patient, a 45-year-old woman, threw herself off a tower block two days after being penalised by having her prescription withdrawn, Erin says.

    And with strict attendance requirements and supervised injections, it prevented users from getting full-time employment.

    Erin claims she was forced off the course after 18 months when she tried to start a support group. She then founded Black Poppy to give a voice to drug users, and address issues missed by treatment programmes.

    Why did I have to wait until I'd finished selling my young body to men?
    After leaving the prescription programme, Erin was put on methadone injections, which she topped up with crack. This period was one of her lowest and her veins began to collapse.

    When she heard about a vacancy on a pioneering prescription course at the Maudsley Hospital in south London, she cornered the doctor in charge at a drugs conference.

    "I remember my sense of complete and total desperation. I felt I could not go on any longer, that if they didn't help me, I didn't know where I would be. I felt that this was my last hope, that I'd tried everything. And I begged."

    Her powers of persuasion paid off and she joined what turned out to be a more flexible programme. She was able, for instance, to spend a few months at her mother's in Colchester and pick up her prescription from a local chemist, so long as she visited the doctor every fortnight.

    Her immune system strengthened, and two years on she is on a reduced dosage and aims to come off heroin completely.

    - 200,000 heroin users
    - 88,000 in treatment , of which 40,000 on methadone
    - Heroin is an opiate which depresses the nervous system
    - It can combat physical and emotional pain
    - Users can feel warm, relaxed and detached
    - Purity of street heroin varies, with a risk of fatal overdosing
    - Unsafe injecting means risk of HIV, hepatitis, abscesses and ulcers
    - Source: DrugScope, NTA
    - As she looks to the future, there is a trace of anger about the years spent on and off treatment programmes.

    "Why did I have to wait until I'd finished selling my young body to men, until I'd got sick and deeply depressed, until I'd used every vein in my body from my neck to my feet, until I'd contracted both HIV and Hep C?"

    But she is optimistic that the government has begun to move in the right direction and listen to what drug users want.

    By Tom Geoghegan

    BBC News Online
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